Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 2.
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Sanofi Genzyme Support Program (MyEloctate)

This program provides brand name medications at no or low cost

Provided by: Sanofi Genzyme

Attn: Patient Services
225 2nd Avenue
Waltham, MA 02451

TEL: 855-693-5628


FAX: 855-398-7634
Languages Spoken:

English, Others By Translation Service

Program Website

 

Program Applications and Forms

Sanofi Genzyme Enrollment Form (MyEloctate)

 

Medications

  • antihemophilic factor (recombinant), fc fusion protein injection; iv lyophilized powder (Eloctate) Injection; IV Lyophilized powder
 

Eligibility Requirements   

Insurance Status *Contact program for details.
Those with Part D Eligible? No
Income Household income at or less than $150,000
Diagnosis/Medical Criteria Medically Necessary as determined by a Doctor
US Residency Required? Must be treated by US licensed healthcare provider and use a US pharmacy
   

Application

Obtaining Call or download
Receiving Faxed or downloaded from website
Returning Fax
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Patient and Doctor are notified
Decision Timeframe Varies
   

Medication

Amount/Supply 30 day supply
Sent To Doctor's office or patient's home
Delivery Time Once approved; shipped next business day
Refill Process Patient or Doctor must contact company
Limit Contact the program for details
Re-application New application every 12 months
   

Additional Information

Contact program for more information.

Updated July 08, 2020


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 2.
 

Patient Access Network Foundation (PAN)

This is a copay assistance program

Provided by: Patient Access Network Foundation


TEL: 866-316-7263


FAX: 866-316-7261
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

Patient Access Network Foundation (PAN) Application: Contact program

 

Medications

  • antihemophilic factor (recombinant), fc fusion protein (Eloctate) 
 

Eligibility Requirements   

Insurance Status *See Additional Information section below
Those with Part D Eligible? Determined case by case
Income Between 400-500% of FPL
Diagnosis/Medical Criteria FDA Approved Diagnosis - See Program Website for Details
US Residency Required? Must reside and receive treatment in US
   

Application

Obtaining Call or complete online
Receiving Complete online or by phone
Returning Complete online or by phone
Doctor's Action Will be discussed with patient and Doctor after request is received
Applicant's Action Call for information or inform doctor that he/she is in need
Decision Communicated Patient and Doctor notified in writing
Decision Timeframe Within 48 hours
   

Medication

Amount/Supply Not applicable
Sent To Patient sent card to be used at pharmacy
Delivery Time Once approved; shipped same day
Refill Process Patient presents voucher/card to pharmacy for each refill
Limit None
Re-application New application every 12 months
   

Additional Information

*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance.

Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly.

Note: All new enrollment is now done electronically or over the phone. Contact program for details.

Updated September 01, 2020